Liver Cancer Surveillance
Ultrasound + AFP every 6 months for patients with cirrhosis or chronic hepatitis B catches liver cancer early — when curative treatment is possible. The single most important thing you can do for these conditions.
Category
Screening
Red flags
1
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Hepatocellular carcinoma (HCC) almost always develops in patients with chronic liver disease — especially cirrhosis and chronic hepatitis B. When found small (<3 cm) on surveillance, cure rates are high. When found late, treatment is palliative. Surveillance is the single most important factor in survival.
How common is it?
HCC risk: ~3-5% per year in patients with cirrhosis. Lower in chronic hepatitis B without cirrhosis (~0.5%/year).
Why does it happen?
Years of liver inflammation lead to genetic damage and eventually cancer. Higher risk: cirrhosis from any cause, chronic hepatitis B (even without cirrhosis), MASH, alcohol, hemochromatosis, Asian/African ancestry, family history of HCC.
Symptoms
- Surveillance is for ASYMPTOMATIC patients — the goal is to find HCC before symptoms
- When symptoms appear, the cancer is usually advanced
Red flags — seek urgent medical care
Worsening cirrhosis (new ascites, jaundice, weight loss)
Investigate for HCC and other causes.
How is it diagnosed?
Surveillance: liver ultrasound + AFP every 6 months. Suspicious lesion → triple-phase CT or MRI with contrast — these can diagnose HCC without biopsy in many cases. Biopsy if imaging uncertain.
Outlook — what to expect
Early HCC found on surveillance: 5-year survival often >70% with surgery, transplant, or ablation. Late HCC: median survival 6-12 months. Surveillance saves lives — adherence is the challenge.
Treatment
Habits & Lifestyle
Adherence to surveillance schedule is the critical task.
- Get ultrasound + AFP every 6 months without fail.
- Treat underlying liver disease aggressively (antivirals for HBV, weight loss for MASLD, abstinence from alcohol).
- Stop alcohol completely.
- Vaccinate against hepatitis A and B.
Diet
Mediterranean diet plus underlying disease management.
- Coffee 3-4 cups daily (unsweetened) is protective.
Medications
No specific drugs for screening — treat underlying liver disease.
- Antivirals for chronic hepatitis B can reduce HCC risk.
Procedures & Surgery
Surveillance is the procedure.
- Ultrasound + AFP every 6 months.
- CT or MRI for suspicious lesions on ultrasound.
- Treatment depends on stage at detection.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- When is my next ultrasound and AFP due?
- Am I in the high-risk group requiring surveillance?
Medically reviewed by: SGA Hepatology Panel · Last reviewed 24/04/2026